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ICD-10 Guide
ICD-10 CodesS42.263

S42.263

Billable

Displaced fracture of lesser tuberosity of unspecified humerus

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/24/2025

Code Description

ICD-10 S42.263 is a billable code used to indicate a diagnosis of displaced fracture of lesser tuberosity of unspecified humerus.

Key Diagnostic Point:

A displaced fracture of the lesser tuberosity of the humerus typically occurs due to trauma, such as a fall or direct impact to the shoulder. The lesser tuberosity is a small bony prominence on the humerus where the subscapularis muscle attaches. This type of fracture can lead to significant pain, limited range of motion, and potential complications if not treated properly. Patients may present with shoulder pain, swelling, and difficulty in performing overhead activities. Diagnosis is usually confirmed through imaging studies such as X-rays or MRI, which can reveal the extent of the fracture and any associated soft tissue injuries. Treatment often involves orthopedic intervention, which may include surgical repair, especially if the fracture is significantly displaced. Rehabilitation is crucial for restoring function and strength to the shoulder joint post-injury. The management of this fracture requires careful consideration of the patient's overall health, activity level, and specific needs to ensure optimal recovery.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variability in fracture presentation and severity
  • Need for precise documentation of displacement
  • Potential for associated soft tissue injuries
  • Differentiation from similar humeral fractures

Audit Risk Factors

  • Inadequate documentation of fracture type and displacement
  • Failure to document associated injuries
  • Incorrect coding of laterality or unspecified humerus
  • Lack of clarity in surgical reports

Specialty Focus

Medical Specialties

Orthopedic Surgery

Documentation Requirements

Detailed operative notes, imaging reports, and post-operative care plans.

Common Clinical Scenarios

Fractures resulting from falls, sports injuries, or accidents requiring surgical intervention.

Billing Considerations

Ensure accurate documentation of fracture characteristics and surgical techniques used.

Physical Therapy

Documentation Requirements

Progress notes detailing rehabilitation exercises and patient response.

Common Clinical Scenarios

Post-operative rehabilitation following surgical repair of humeral fractures.

Billing Considerations

Document functional limitations and progress towards recovery.

Coding Guidelines

Inclusion Criteria

Use S42.263 When
  • Follow official ICD
  • 10 coding guidelines, ensuring accurate documentation of fracture type, displacement, and any associated injuries
  • displaced fractures or fractures of other parts of the humerus

Exclusion Criteria

Do NOT use S42.263 When
  • Exclude codes for non

Related ICD-10 Codes

Related CPT Codes

23470CPT Code

Repair of rotator cuff

Clinical Scenario

Used when a rotator cuff repair is performed alongside fracture repair.

Documentation Requirements

Operative report detailing the procedure and findings.

Specialty Considerations

Orthopedic surgeons should document the relationship between the fracture and any rotator cuff injuries.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of fractures, including the ability to denote displacement, which is crucial for treatment planning and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of fractures, including the ability to denote displacement, which is crucial for treatment planning and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the significance of coding S42.263 accurately?

Accurate coding of S42.263 is essential for appropriate reimbursement, ensuring that the complexity of the injury is recognized and that the treatment provided is adequately documented.